Table 1.

Phases of the CTC Prevention System: Typical implementation and notable aspects of implementation by the Hazel Park Community Coalition.

	Typical Implementation	Hazel Park Community Coalition Notable Aspects of Implementation
Phase I: Get Started	Overarching Goal: Assess community readiness and position the community to undertake collaborative prevention activities. Identify key leaders within community, preferably through a champion willing to encourage CTC as a prevention strategy. Hold meetings with potential leaders to assess community readiness to adopt CTC and local implementation barriers. Hire a coordinator to facilitate coalition activities; the convening organization typically hires the coordinator. Obtain school district support for administering the CTC student survey, which provides epidemiologic data to compare to national norms to identify elevated risk factors and depressed protective factors in the community. a	Principal of partnering school acted as coalition’s CTC champion and provided names and contact information of potential key leaders; these individuals in turn recommended others. Coalition coordinator was hired by University research partner; this person held meetings with potential leaders and conducted readiness interviews. Coalition was unable to obtain school district support for a passive consent procedure for administering anonymous CTC student surveys to students. School administrators and other coalition members expressed concern that a disproportionate number of survey items assessing risk factors and behaviors could lead youth and other community members to feel labeled. Selected survey items assessing substance use were removed because they were not essential to the creation of composite variables that would be compared to national norms. b In place of removed items, coalition members inserted items to reflect local concerns (e.g., experiences of discrimination). Coalition planned a supplemental survey of black male youth and their caregivers.
Phase II: Organize, Introduce, and Involve	Overarching Goal: Form a diverse and representative coalition to coordinate prevention efforts. c Community leaders garner support for prevention and identify candidates for the CTC community board. Community board develops a vision statement and establishes workgroups to transform this vision into action. Together, the community leaders and board comprise the coalition.	Reflecting pre-existing relationships, leaders included heads of youth-serving organizations within the focal urban neighborhood, as well as professionals focused on the well-being of diverse youth and families within the county. Coalition members included stakeholders from government (1), law enforcement/justice (1), education (6), health (4), social services (1), the faith community (1), culture/diversity (1), neighborhood groups (1), parent groups (2), and youth serving organizations (3). With consultation from the Center for Communities that Care, length, content, and language of CTC PLUS materials were adjusted to better fit the time constraints of coalition members and community culture. Opinions of caregivers were sought during monthly parent-teacher organization meetings. As an engagement tool, the coalition distributed newsletters every 3-4 months to caregivers via mail and children’s backpacks.
Phase III: Develop a Community Profile	Overarching Goal: Identify risk and protective factors that are a priority for prevention efforts. Use local epidemiologic data (e.g., CTC youth survey, rates of student suspensions and mobility) to identify risk and protective factors in the community. Assess existing prevention resources to determine the degree to which resources are evidence-based, accessible, and being utilized by members of the community.	Inability to obtain school district support for a passive consent procedure resulted in a low participation rate among 6th and 8th grade students who were administered the CTC student survey (57%); this meant that data was less likely to be representative of the school as a whole. CTC student survey data was augmented by archival data within community (e.g., school-level student attendance; standardized test scores; suspensions; proportion of students receiving free and reduced lunch; retention of students over time, an indicator of family mobility; school district graduation rates). Assistance from coalition coordinator, hired full time to facilitate work of the coalition, proved essential to following the CTC process – particularly, conducting research into existing community resources and different prevention program options, and documenting coalition efforts and key decisions. Community board selected four CTC factors for preventive action: academic failure, depressive symptoms, early and persistent antisocial behavior, and transitions and mobility. Three selected factors were reframed in positive terms to inspire coalition and community members (i.e., academic engagement, emotional well-being and mental health, positive social skills).
Phase IV: Create a Community Action Plan	Overarching Goal: Choose one or more evidence-based prevention policies and programs that target the coalition’s identified factors. d Resource Assessment workgroup identifies programs that may fill service gaps and reports results to the community board. Community board develops a community action plan.	A review of the Blueprints for Healthy Youth Development website yielded seven initial candidate programs: Good Behavior Game,41 Positive Family Support,42 Raising Healthy Children,43 Positive Action,44 Promoting Alternative Thinking Strategies (PATHS),45 Reading Recovery,46 and the Olweus Bullying Prevention Program (OBPP).31 Board members encouraged selection of OBPP to address positive social skills. Coalition members reached out to two communities who were implementing OBPP to confirm that the program would be a good fit.
Phase V: Implement and Evaluate the Community Action Plan	Overarching Goal:Implement and evaluate the community action plan, which positions the coalition to adjust programming as indicated. Implement selected prevention programs with fidelity. Evaluate impact of prevention programs on youth behaviors.	The principal of the partnering school and the branch director of the local Boys & Girls Club agreed to implement OBPP within their organizations. All school and Boys & Girls Club staff received training in OBPP implementation and monitoring of fidelity by a certified trainer with 5 years of experience; this individual provided consultation to each site for one year. Evaluation of OBPP is currently underway. Coalition intends to expand community action plan to encompass remaining coalition priorities (family transitions and mobility, academic engagement, and emotional well-being and mental health).

^a“On average, 89% of students completing the CTC Youth Survey as part of the 24-community RCT were white (range, 64% to 98%), 3% were black (range, 0% to 21%), 10% were of Hispanic origin (range = 1% to 65%), and 37% were eligible for free or reduced-price lunch (range, 21% to 66%).”

^bLifetime and “past 30 day” use of the following items were removed from the CTC Youth Survey: LSD or other psychedelics; cocaine or crack; MDMA ("ecstasy"); sniffing glue, breathing the contents of an aerosol spray can, or inhaling other gases or sprays in order to get high; Tyrexatine ("T-Rex", "Reck"); methamphetamines ("meth"); prescription opiate pain relievers, such as Vicodin^®, OxyContin^®, or Tylox^®, without a doctor's orders; prescription tranquilizers, such as Xanax^®, Valium^®, or Ambien^®, without a doctor’s orders; prescription stimulants, such as Ritalin^® or Adderall^®, without a doctor’s orders. Questions assessing alcohol, tobacco, and marijuana use were retained.

^cFor the CTC RCT within smaller-sized cities and towns,^6,7 leaders included policymakers at the city level (e.g., mayor, police chief, school district superintendent).

^dCTC recommends using the University of Colorado’s Blueprints for Healthy Youth Development website (www.blueprintsprograms.com) for a menu of the most rigorously evaluated evidence-based programs.